설근부암의 수술적 접근방법과 재건방법의 선택

Abstract

Background and Objectives: There are various surgical approaches for resection of base of tongue cancer, but reports on indications of each approach are lacking. Patients and Methods: From 1993 to 1999, surgically treated patients with base of tongue cancer were reviewed retrospectively. Fourteen patients were included in this study. All but one were previously untreated. Approaches used to remove the tongue base lesions were as follows: lateral pharyngotomy, transhyoid pharyngotomy, mandibular swing approach with or without supraglottic partial laryngectomy(SPL), extended supraglottic partial laryngectomy(ESPL), lingual release or lingual-mandibular release technique, and pull through approach. Free flap or myocutaneous flap were used for the reconstruction of surgical defect in five patients. Results: Surgical resection margin was positive in five patients. In these, the lateral wall of oropharynx was the most frequent site of positive margin. All patients, except one total laryngectomee, could do well without tracheostoma and oral feeding was possible in all cases. Conclusions: In small lateral tumor, transpharyngeal resection was a good alternative for vigorous transmandibular resection. In case of tumor with vallecular or supraglottic involvement, supraglottic partial laryngectomy with or without mandibular swing was needed. For total glossectomy, lip and mandible could be spared with pull through or lingual release approach. Even though we could choose any surgical approach with very wide surgical field, we needed more generous safety margin for this notorious tongue base cancer.